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Review: Available Evidence Linking Vaping to Smoking Initiation is Weak

A systematic review and meta-analysis of studies looking into the tobacco use patterns of young people who used e-cigarettes prior to taking up smoking, found it difficult to conclude whether nicotine is actually the driving mechanism behind this association.

Diane Caruana

April 7, 2021

Analysing studies published in PubMed, Embase, Web of Science, Wiley Cochrane Library databases, and the 2018 Society for Research on Nicotine and Tobacco and Society for Behavioural Medicine conference abstracts, the current review aimed to investigate whether e-cigarette use was associated with cigarette smoking when compared to non-use.

Of 9199 results, the researchers included 17 studies in the meta-analysis. “There was strong evidence for an association between e-cigarette use among non-smokers and later smoking (OR: 4.59, 95% CI: 3.60 to 5.85) when the results were meta-analysed in a random-effects model. However, there was high heterogeneity (I2 =88%),” they reported.

Weak evidence for the association between vaping and uptake of smoking

Most studies failed to consider the level of nicotine contained in the products used by the participants, hence one cannot infer that nicotine is the driving mechanism behind this association.

The paper explained that while the association between vaping among non-smokers and subsequent smoking appears strong, the evidence is considered weak for a number of factors. Firstly, data was collected via self-report measures of smoking history and was not biochemically verified.

Secondly, none of the studies included negative controls which would provide stronger evidence for whether the association may be causal. Moreover, much of the evidence also failed to consider the level of nicotine contained in the vaping products used by the participants, hence one cannot infer that nicotine is the driving mechanism behind this association.

Smoking cessation via vaping

Meanwhile, a recent interventional-cohort study aimed to determine whether smokers who attempt quitting via vaping report similar quit rates as those using commonly recommended smoking cessation aids.

The study titled, “Electronic cigarettes in standard smoking cessation treatment by tobacco counselors in Flanders: E-cigarette users show similar if not higher quit rates as those using commonly recommended smoking cessation aids,” looked into the smoking cessation success of smokers who attempted to quit via vaping.

Participants were recruited by tobacco counselors, and followed a smoking cessation treatment (in group) for 2 months. The participants were followed for 7 months after quit date, and asked to fill out questionnaires and to perform eCO measurements.

“One third of all participants (n = 244) achieved smoking abstinence 7 months after the quit date, with e-cigarette users having higher chances to be smoking abstinent at the final session compared to NRT users,” reported the researchers.

“People who smoke and choose e-cigarettes in the context of smoking cessation treatment by tobacco counselors show similar if not higher smoking cessation rates compared to those choosing other evidence-based (or no) smoking cessation aids,” they concluded.